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CONSTIPATION: CAUSE, PREVENTION, 
AND CURE 



The Voice of Exercise 

I GIVE the sparkling eye that knows no fear, 
The springy step that lightly treads the ground, 

The heart that pumps the red blood rich and clear — 
A stream of health upon its mission bound. 

I give the shoulders broad, the deep, strong chest, 
The well-pcised head where Reason keeps her throne, 

The arm with steely muscles well possessed — 
A weapon fit to cope the world alone. 

Away with dissipation, man, be free; 

Make me thy friend, and lengthen life's short span; 
I am one of God's greatest gifts to thee — 

An antidote that helps to make the man. 

— Ceorge H. Herbert. 




Fa<*3 



CONSTIPATION 

Cause, Prevention, and 
Cure 



By GEORGE H. HEALD, M. D. 
Editor of "Life and Health" 



1921 



REVIEW AND HERALD PUBLISHING ASSN. 

Washington, D. C. 
New York City, N. Y. Oshawa, Ontario, Canada 

South Bend, Ind. Winnipeg, Manitoba, Canada 






Copyright, 1921 

Review and Herald Publishing Assn., 

Washington, J). C. 



MAY 25 1921 
0>CU617108 



FOREWORD 

Many regions have their local health prob- 
lems, — the prevention of malaria, typhoid, pel- 
lagra, hookworm infection, plague, etc. Such dis- 
eases are recognized as preventable, and their 
prevention is largely a public health problem, to 
be solved by improved health administration. 
But constipation is an ever-present malady, not 
confined to any locality. It is not an infection. 
It is not a public health problem. It is a prob- 
lem for each person to solve for himself. 

This booklet is not published because there 
has not been a host of books and articles on the 
subject, but because, for some reason, the knowl- 
edge of preventive and curative measures has not 
reached those who need it most. 

The contents of the following pages are very 
largely borrowed, though the results have in most 
cases been verified by the author, and this must 
be taken as his acknowledgment; for what the 
writer knows of the subject he is indebted largely 
to the accumulated experience of others. If he 
has succeeded in arranging this information in a 
form that will be helpful to the ordinary reader, 
he is amply repaid for his trouble. 

The Author. 




Organ* of Digestion 



CONSTIPATION: CAUSE, PREVENTION, 
AND CURE 

The Digestive Tube 

When food is eaten, it enters, not the body 
proper, but a tube about thirty feet long, which 
passes through the body. This tube, known as 
the alimentary canal or alimentary tract, is a 
device in which the food may be finely divided, 
and by means of certain " juices " changed chem- 
ically into substances fit for absorption into 
the blood stream. In the wall of this tube are 
grinders (the teeth) for reducing the food, and 
glands for producing the juices necessary to lu- 
bricate the food for its onward passage, and to 
digest it, or prepare it for absorption. 

The wall of the tube is also provided with a 
mechanism — muscular and nervous — for pro- 
pelling the food along the tract, and for expelling 
from the body the residue that is not utilized. 
It is this propulsive function which is disturbed 
in constipation, and with which we are concerned 
in the present study, though there may be other 
changes, such as the alteration of the bowel se- 
cretions. 

The only part of the entire thirty feet of the 
digestive tube under control of the will, is the 
first portion — the mouth and the upper part of 

9 



10 Constipation 

the throat. Until the food is swallowed, it is 
under voluntary control. After that, the action 
of the tube is entirely automatic. If we desire to 
control its functions, we must do so at the mouth, 
making a proper selection of food, and preparing 
it by thorough mastication before swallowing it. 
There is a limited control of the tube at the exit ; 
that is, when there is a call to relieve the bowels, 
one may refuse to answer the call, and by mus- 
cular effort may delay the action; or one may 
sometimes hasten action by muscular effort. But 
this voluntary control, if too freely exercised, is 
likely to result in harm, as will be explained later. 
The tube varies in size, the largest expansion 
being the stomach, which follows next in order 
after the comparatively short throat, or esopha- 
gus. From the stomach the flow is through a 
small and very contorted tube somewhat more 
than twenty feet in length, called the small intes- 
tine. At a point near the right groin the small 
intestine empties into the large intestine, or colon, 
which has been divided by anatomists as follows : 
The ascending colon, extending upward to a point 
near the lower border of the ribs ; the transverse 
colon, reaching across to the left side; the de- 
scending colon, passing down to a point near the 
left groin; a convoluted, or S-shaped, portion, 
known as the sigmoid flexure of the colon; and 
finally, a straight portion, known as the rectum, 
ending in the orifice known as the anus. 



Cause, Prevention, and Cure 11 

There are in this passage several constricted 
portions, or sphincters, — one at the entrance of 
the stomach, another at the outlet of the stom- 
ach, and a third at the anal orifice. Then there 
is a valve, the ileocsecal valve, at the junction of 
the small intestine and the colon, which permits 
the contents to flow forward but not backward. 

Throughout its entire length the tube has mus- 
cular fibers in its wall, whose function it is, by 
causing wormlike contractions of the tube, to 
churn and mix the food and propel it forward. 
In constipation there may be a tightening of the 
sphincter muscles, or more frequently a weaken- 
ing of the propulsive muscles, or, what amounts 
to the same thing, a lack of sensitiveness of the 
nervous mechanism controlling the muscles. 

What Is Constipation? 

Constipation is an abnormality in the intestinal 
discharges, characterized by infrequency, dryness, 
and lessened quantity. Just what amount of va- 
riation constitutes constipation is difficult to de- 
cide, for persons who appear to be in perfect 
health vary within somewhat wide limits. Some 
persons consider themselves constipated, and com- 
plain of ill effects, if they fail to have two or three 
abundant movements a day. Others seem to be 
in good health who have movements at intervals 
of one, two, or three days; and cases have been 
recorded where movements occurred at intervals 



12 Constipation 

of two weeks or more, without apparent ill ef- 
fects. 1 But ordinarily one who does not have daily- 
movements at approximately the same time of 
day, is considered to be constipated. There are, 
of course, great variations in the degree of con- 
stipation. 

Constipation is not always manifested by inf re- 
quency, but by variation in the quantity or quality 
of the discharges, they being small in amount or 
impacted, or both, and the movements accom- 
panied by more or less distress. 

Again, there is a type of constipation which is 
detected only by giving the patient charcoal or 
some other pigment with the meal. In such cases 
it may be demonstrated that although the move- 
ments occur at proper intervals, and are soft and 
voluminous, too much time elapses between the 
ingestion of the food and the discharge of the 
residue. This latent constipation, of which the 
patient may have no knowledge, may be a con- 
tributing cause of auto-intoxication, with its mul- 
tifarious symptoms. 

The Nature of Constipation 

When the bowel is functioning properly, cer- 
tain secretions are thrown into the tube, and the 
contractions of the muscular layers of the intes- 
tinal wall cause the food to move slowly onward. 



1 Gant records two cases that came under his personal observation, 
who had had no movement for six months, and yet were, aside from the 
discomfort, in good health. 



Cause, Prevention, and Cure 13 

In the small intestine the contents are fluid, but 
in the large intestine absorption gradually ab- 
stracts the fluid, and the consistency of the mass 
increases. 

In constipation there may be a lack of balance 
between secretion and absorption, so that the 
bowel contents become abnormally dry; but usu- 
ally this dryness is the result of the prolonged 
stay in the tube, and is attributable to the sluggish 
movement. There may be feebleness of the mus- 
cles of the intestinal wall, but more likely there 
is a lack of sensitiveness to stimulation. This in- 
sensitiveness is usually caused by the use of arti- 
ficial stimulants, such as cathartic drugs, though 
frequent enemas may produce the same result. It 
is a principle governing all functions of the body, 
that if they are performed under artificial stim- 
ulation, the organs involved come to depend on 
stimulation and refuse to act without it. This 
principle is so well understood that it needs only 
to be referred to. It is as easy to form a ca- 
thartic habit or an enema habit as it is to form 
a tobacco habit or a liquor habit. 

Another condition present in constipation is 
insensitiveness of the lower bowel, or rectum. 
Normally, when the fecal matter reaches the end 
of the intestine, it causes a feeling of uneasiness 
that almost compels one to seek relief ; but if one 
in the performance of his social obligations or his 
tasks resists the impulse, the uneasiness finally 



14 Constipation 

ceases. This method of disarranging nature's 
mechanism may be repeated until one can easily 
resist the impulse, and gradually the bowel be- 
comes quite insensitive and fails to register the 
presence of fecal matter. Meantime the automatic 
mechanism which aids in the expulsion of the 
feces has become enfeebled, and every bowel move- 
ment necessitates a voluntary and strained effort. 
Perhaps the presence of fecal matter for long 
periods, with the effort to hold it back, has over- 
developed the sphincter muscle — the ring mus- 
cle at the end of the passage which prevents 
involuntary discharge — until it requires violent 
straining to force the hardened masses past the 
obstruction. In some cases when a call is not 
heeded, the bowel contents are forced backward 

— that is, upward — to undergo further drying 
and hardening. 

Another condition often present in cases of con- 
stipation is feebleness of the abdominal muscles 

— the muscles which have to do with the volun- 
tary effort of expelling the feces. This is part of 
a general muscular inefficiency, the result of neg- 
lect to take physical exercise. 

According to one authority, the lower bowel 
may become " greatly elongated, . . . and capable 
of retaining the fecal matter for several days, 
even though a small piece may be broken off and 
evacuated daily, thus giving rise to a false im- 
pression of bowel regularity." 



Cause, Prevention, and Cure 15 

There may be strictures of the bowel, adhesions, 
" kinks," and the like, requiring some surgical 
operation; but most frequently constipation is 
functional in its nature, the result mainly of 
faulty habits of life. 

Causes 

The habitual use of food that does not contain 
sufficient residue, is a common cause of consti- 
pation. Normally, the menu should contain a 
considerable amount of indigestible matter, to 
give bulk and to furnish the necessary physiolog- 
ical stimulation to the bowels. In some cases the 
exchange from white-flour bread to coarse whole- 
wheat or Graham bread is sufficient, without any 
other measures, to correct constipation. Other 
foods which leave insufficient residue are milk, 
eggs, meat, and white rice. If the diet consists 
largely of such foods, to the neglect of the coarser 
foods, — the whole grains, including brown rice, 
the fruits, and the fibrous vegetables, — the tend- 
ency will be to have irregular and delayed bowel 
action. There is an exception, however, in the 
more rare form of spastic constipation, in which 
coarse foods are injurious, as will be explained 
later. 

Another cause of constipation is the failure to 
drink a sufficient amount of water. If an insuf- 
ficiency of fluid is taken, the tendency is for the 
bowel contents to become abnormally dry. 



16 Constipation 

The use of easily fermentable foods in some 
cases results in certain fermentations, with the 
formation of gas, which may be followed by 
delayed peristalsis, or constipation. The use of 
easily putrefiable foods, as meat, may thus be a 
contributory cause of constipation. Sometimes 
fruit, instead of favoring a movement, ferments, 
with the formation of great quantities of gas, and 
consequent abdominal distress and delayed bowel 
movements. Both rapid eating and overeating, 
by favoring fermentation, predispose to consti- 
pation. 

A sedentary habit, with neglect to exercise the 
voluntary muscles, has an unfavorable effect on 
the involuntary muscles which control the move- 
ment of the intestinal contents. Moreover, the 
voluntary abdominal muscles, which aid in empty- 
ing the bowel, are involved in the general mus- 
cular weakness. 

The use of certain forms of corsets tends to 
constipation in at least two ways. By disarrang- 
ing the abdominal organs, the intestine is forced 
down in such a way as to increase the folds, or 
"kinks." Any one who has sprinkled a lawn 
knows what occurs when there is a kink in the 
hose — the flow stops. Imagine a more or less 
permanent kink in the bowel caused by the ex- 
ternal pressure of a corset. Another way in 
which the corset interferes with the bowel func- 
tion is by weakening the abdominal muscles. 



Cause, Prevention, and Cure 17 

Normally, there is a time each day — usually 
after breakfast — when the bowel contents reach 
the last portion of the bowel, known as the pelvic 
portion, or rectum, and there is a desire for re- 
lief. Those who always heed this warning and 
immediately seek relief, rarely experience the ill 
effects of constipation. They may suffer a tem- 
porary delay when on a diet deficient in coarse 
material, but the restoration of a right diet will 
remedy the matter. However, the person who has 
continually neglected nature's call, gradually finds 
that these calls come at greater intervals, and 
are feeble at best. 

It is then that a bad matter is likely to be made 
worse by the use of cathartic drugs. The bowel, 
having been made insensitive, is rendered still 
more so by the artificial stimulation. The habitual 
use of enemas or suppositories does not give much 
better results than the use of cathartics. This is 
not to say that an enema, a suppository, or even 
a cathartic should never be used. As an emer- 
gency measure any one of them may be productive 
of good, but as a routine measure all are likely to 
cause more harm than good. 

Depressed mental states, such as worry, anger, 
or fear, retard all the bodily functions, including 
that of the intestine. Other conditions which 
often favor or induce constipation, are removal 
of the appendix, the presence of a tumor, and 
pregnancy. 



18 Constipation 

Habit 

As has already been explained, there are just 
two parts of the food passage under control of 
the will, the entrance and the exit — not more 
than a foot altogether of the thirty feet compos- 
ing the entire passage. And yet it is because of 
the misuse of the voluntary part, that practically 
all the troubles come to the involuntary part. 
Man is dyspeptic because through ignorance or 
indifference or lack of self-control he eats the 
wrong things, in the wrong quantity, and in the 
wrong way. That part of the tube which he can 
control, he does not control to his own advantage, 
and the rest of the tube makes a protest in va- 
rious forms of indigestion, and the body as a 
whole makes protest in the form of auto-intoxi- 
cation and other ailments. 

In a similar way, the part of the bowel that is 
under control is not controlled wisely. When 
a call comes for relief, if some business or social 
matter is pressing, the call is unheeded. It may 
at first cause considerable discomfort, but little 
by little the sensitiveness of the lower bowel is 
lessened, the impulse to secure evacuation de- 
creases and finally ceases altogether, and no bowel 
action can be obtained without strong muscular 
effort. Then, as the bowel contents have in the 
meantime become hardened, it may be necessary 
to have some assistance in the way of a cathartic 
or an enema ; and this, while affording temporary 



Cause, Prevention, and Cure 19 

relief, in the long run lessens further the sensi- 
bility of the intestinal mucous membrane, and 
renders the constipation more obdurate. To two 
main causes, then, we may attribute constipa- 
tion: (1) To the unhealthy condition of the in- 
testine, because of wrong eating habits; and (2) 
To the lessened sensibility of the lower bowel, 
the result of failure to answer promptly nature's 
calls. 

Classes of Constipation 

The vegetative, or involuntary, functions of the 
body are controlled by nerve impulses from two 
sources. These impulses are antagonistic to each 
other. For instance, the small blood vessels have 
a nerve supply which causes the involuntary mus- 
cles in the vessel walls to contract, and thus re- 
duce the size of the vessels. The function of the 
antagonistic nerves is to inhibit or stop the action 
of these nerves, and allow the vessels to dilate. 
When the constrictors of the blood vessels of the 
face are in action, the face becomes pale; when 
the dilators are in action, the face is flushed. So 
there are nerves for increasing and nerves for 
decreasing heart action,. for contracting and for 
dilating the pupil of the eye, for increasing and 
for decreasing the muscular action in the intes- 
tinal wall, etc. In health, these paired influences 
are so balanced as to produce results tending to 
the general welfare of the body, providing for the 



20 Constipation 

proper amount of blood flow, of heart action, of 
intestinal movement, etc. But in certain condi- 
tions, the influence of one or the other of these 
innervations may be excessive, producing condi- 
tions known respectively as hypertonia and hypo- 
tonia. One or the other of these conditions is 
often found to be present in those of sedentary 
habits, the lack of sufficient exercise and fresh 
air combining to cause unbalanced nerve action. 
Constipation in hypertonic patients (spastic 
constipation) is due to overaction, or spasm, 
of the intestinal muscles. The evacuations are 
unsatisfying. The stools are small like a pen- 
cil, dried, and dark in color, and are voided in 
small sections. One passing the hand over the 
abdomen, at the left, may feel hardened cords. 
The patients are nervous men or women who do a 
large amount of brain work, and who do not live 
under ideal hygienic conditions. Among the in- 
dulgences which may help to contribute to this 
condition are the use of tobacco, 1 alcohol, and 
spices. In these cases there is usually more or less 
nerve strain or mental unrest. Excessive acidity 
of the stomach, gallstones, or piles may be pres- 
ent as accompanying conditions. This overaction 
of the intestinal muscles is most readily recog- 
nized by means of the X-ray in connection with 



1 Some patients do not seem to be able to have a movement until they 
have had a smoke. The tobacco gives temporary relief, but perpetuates 
and even aggravates the evil. 



Cause, Prevention, and Cure 21 

a barium meal. 2 Among the symptoms may be 
headache and various other neuralgic or rheu- 
matic pains, sleeplessness, depression, and loss of 
memory. Coarse foods increase the trouble. 

Constipation in hypotonic patients (the more 
common form) is due to relaxation of the intes- 
tinal muscles, or failure to respond to the ordi- 
nary stimuli. Patients with this condition may 
be apparently in good health, may be well nour- 
ished, even fat ; but they are anemic, and there is 
a general flabbiness or lack of tone, especially of 
the involuntary muscles, including the muscles of 
the intestinal wall. The abdominal muscles are 
poorly developed, the abdominal organs are more 
or less prolapsed, and the abdomen protrudes. 
There may be intestinal catarrh, with decreased 
secretion of the intestinal juices. 

A bland diet, owing to its lack of stimulating 
effect, will, with such patients, increase the tend- 
ency to constipation. 

Habit constipation, the result of irregular hab- 
its and neglect in respect to the bowel functions, 
usually begins early in life — rarely if ever after 
twenty-five, and usually much before that age. 
If it is unaccompanied by any other abnormality, 



3 The X-ray penetrates the soft tissues of the body. Hard or dense 
tissues, especially the bones, cast shadows. In examining: an X-ray pic- 
ture, we are studying the shadows cast by the denser tissues. Ordinarily 
the stomach and intestines cast no shadows ; but if a meal is eaten which 
contains some metallic salt (barium, usually), shadows giving the exact 
outline of the stomach and of the different sections of the intestine, may 
be obtained, as the food progresses through the tube. 



22 Constipation 

it is often corrected by the practice of regularity, 
kept up for a few days. 

Rectal constipation, due to disturbance of the 
last section of the bowel, — that part lying within 
the pelvis, — is not affected by any of the various 
laxatives. The surest and best method for ob- 
taining relief from this condition is by the use 
of oil enemas. 

Symptomatic constipation, the result of certain 
abdominal diseases, as cancer, piles, and other 
rectal troubles, usually develops after the age of 
thirty. Its cure is dependent on the cure of the 
primary disease. In order to obtain temporary 
relief, some mild laxative may be used as a 
routine. 

Acute constipation, accompanied by severe ab- 
dominal pain, is probably due to obstruction, and 
may be made worse by the use of cathartics. A 
patient having such a condition should be under 
the care of a physician or a surgeon. The stom- 
ach should be washed with a solution of salt or 
soda, a teaspoonful to a pint of water, using a 
stomach tube. The lower bowel should be emptied 
by means of an enema. 

For temporary constipation of patients who are 
for the time confined to bed, a laxative will be 
found beneficial, and is harmless. Experience 
has shown that the accustomed regularity will 
be re-established when the patient recovers gen- 
eral health. 






Cause, Prevention, and Cure 23 

Accompaniments of Constipation 

The retention of the intestinal contents for long 
periods favors the multiplication of putrefactive 
germs and the consequent formation of bacterial 
poisons in greater quantity than the body can 
readily dispose of. The result is auto-intoxica- 
tion, which may be manifested by foul breath, 
headache, want of appetite, drowsiness, loss of 
memory, dizziness, inability to do mental work, 
and a host of other symptoms. Moreover, when 
the tissues are overwhelmed by intestinal poisons, 
they are less able to resist the inroads of infec- 
tive germs. For that reason one in this condi- 
tion is more liable to be a victim of epidemic 
disease than one whose digestive organs function 
properly. 

Stomach trouble, or indigestion, may accompany 
constipation, both as a cause and as a result 

Rupture is not infrequently a result of strain- 
ing at stool. From the same cause there may 
result emphysema of the lungs, and even cerebral 
hemorrhage, or apoplexy. 

Hemorrhoids, or piles, are likely to be present 
in persistent constipation. 

There may be other rectal abnormalities, such 
as anal fissure, a condition in which the mucous 
lining of the orifice has become ulcerated as a 
result of the effort to empty the bowel of hard- 
ened contents. When there is a fissure, bowel 
movement is extremely painful, and the patient, 



24 Constipation 

in his dread, is likely to postpone matters, thus 
adding to his difficulty. 

Prolapse, or rolling out, of the lower portion 
of the rectum is another very troublesome result 
of persistent constipation, and follows violent 
straining. 

Fistula follows the breaking of a rectal abscess, 
which may have developed as the result of an 
injury caused by the retention of hardened 
masses. 

These local conditions necessitate surgical aid 
by a competent specialist. However, too often the 
supposed " specialist " is a quack, in no way qual- 
ified to perform such work. A patient should not 
intrust himself to any one but a conscientious 
regular physician who has a good reputation in 
his community. 

Chronic constipation often alternates with at- 
tacks of diarrhea. It would seem that the re- 
tained, fermenting mass finally sets up an irri- 
tation which causes excessive bowel action, to be 
followed by another period of constipation. Often 
during the period of diarrhea, when the stools 
are fluid, there is a more rapid absorption of poi- 
sons than during the period of constipation, and 
for the time the patient has severe symptoms of 
poisoning. 

The following are remote conditions which one 
might not suspect of being in any way connected 
with constipation, but as they have been repeat- 



Cause, Prevention, and Cure 25 

edly cured by curing constipation, the connection 
is obvious: probably they are the result of the 
auto-intoxication that frequently accompanies 
persistent constipation : 

Enlarged thyroid has been cured as a result of 
curing a case of chronic constipation. Neuras- 
thenia, with mental symptoms, has yielded to ap- 
propriate treatment of intestinal stagnation; as 
has also rheumatoid arthritis, once supposed, even 
in its early stages, to be an incurable condition. 
The internal use of mineral oil, according to one 
physician, by relieving chronic constipation, has 
repeatedly arrested pyorrhea, or disease about the 
roots of the teeth. And there is testimony of phy- 
sicians that tuberculosis has been arrested and 
cured as a result of giving proper attention to 
the function of the bowels. 

These facts do not mean that all patients hav- 
ing these complaints can be cured by relieving 
their constipation, but it does mean that in all 
such cases the condition of the bowels should be 
looked after early in the treatment. 

Other conditions which have been shown, in 
certain cases at least, to be caused wholly or in 
part by constipation, are Bright's disease, degen- 
erative disease of the heart, diabetes, and epi- 
lepsy; and, as has been shown by Herter, prema- 
ture old age is closely related to constipation and 
intestinal auto-intoxication. 



26 Constipation 

That constipation must result in general de- 
terioration of the body may be inferred from the 
fact that the offensive breath of a badly consti- 
pated person indicates that putrefying matter 
from the bowel is being absorbed into the blood 
current, to be eliminated partly through the lungs. 
Moreover, it is reported that in many cases where 
autopsies have been performed, the bowel is dis- 
tended with feces, a festering, putrefying mass, 
having in the center a small passageway through 
which it has been possible for only a portion of 
the bowel contents to pass. 

Treatment 

Patients suffering from constipation may, with 
reference to the kind of treatment, be divided 
into four classes. The simpler cases will require 
only a few changes in diet. Others will yield 
readily to a change in diet and habits of life, 
with a few simple treatments. Most of the more 
obstinate cases will be relieved after changes in 
methods of eating and living, and prolonged 
treatment. From 5 to 10 per cent of all cases 
may require surgical intervention in order to 
obtain permanent relief. 

In any case, the method of treatment and the 
time required for cure will depend on a number 
of factors. In general, it may be expected that a 
case which has been neglected for years, and in 
which, for a long time, resort has been had to 



Cause, Prevention, and Cure 27 

cathartics or enemas, will require prolonged effort 
and much patience to effect a cure; and in some 
instances, nothing but a surgical procedure will 
be effective. Possibly some simple operation, as 
stretching the sphincter at the outlet of the bowel, 
may suffice. In other cases it may be necessary 
to open the abdomen, break up adhesions, and 
make other changes. The directions in this book 
are for the relief of the non-surgical cases, which 
constitute more than ninety per cent of all cases. 
Unless there is obvious reason for doing so, there 
should be no resort to surgery for the cure of 
constipation until a thorough trial has been made 
of the various dietetic, hygienic, and other non- 
surgical measures. Changes in habits of living 
will, in most cases, cause marked improvement 
and often effect a cure. 

Forming a Right Habit 

Undoubtedly the chief cause of obstinate con- 
stipation, and the most frequent, is the neglect 
to attend to nature's calls. For one reason or 
another, this function is postponed till a more 
convenient time. It may be a business engage- 
ment that interferes, or some social duty, or, to 
go back to school days, it may be the diffidence 
of the child about asking to be permitted to leave 
the room during school hours; for sometimes the 
teacher very grudgingly grants such requests. 
Some pupils may abuse such privileges, and as 



28 Constipation 

a result other pupils, more timid, may have to 
suffer. Then at home, if on a farm or in the 
suburbs, the old-fashioned privy may be a long 
distance from the house. It may be difficult to 
get to it without being observed by passers-by. It 
is also inconvenient to reach during bad weather. 
For these and other reasons, it becomes a regular 
thing to postpone attending to this function, until 
the lower bowel loses its sensitiveness. While 
there are other causes of constipation, the one 
just mentioned is in most instances the principal 
cause; and treatment, to be effective, should 
begin with the re-formation of a right habit. 

Some time each day should be selected, prefer- 
ably just after breakfast, as that is the time na- 
ture selects, to go to the toilet, and there, with 
mind concentrated on this function, wait. Some 
might suggest here the use of the enema; but if 
it is used at all, it should be only as an emergency 
measure, diminishing temperature and amount 
from day to day, as described later. But the daily 
habit of going to the toilet should be established, 
and there should be no exceptions. Whatever the 
urgency of other matters, this should be made 
first. Only by such a determined attitude will the 
habit of neglect be overcome. If this program is 
kept up faithfully, with the other measures here 
outlined, the result will be, in most cases, a grad- 
ual but complete restoration of the natural desire 
and function. 



Cause, Prevention, and Cure 29 

Diet 

The victim of constipation should change to a 
diet that will give an abundant intestinal resi- 
due. 1 Unless there is spastic constipation, or 
some stomach trouble that forbids, it is well to 
use liberally of coarse vegetables and fruits, with 
whole-grain preparations. 2 Bran, eaten with a 
little milk, cream, or fruit juice, in connection 
with one or more meals each day, proves very 
beneficial in some cases. One or two heaping 
tablespoonfuls are usually sufficient. 

In constipation it is important to drink freely 
of water. Six or eight glasses a day, at inter- 
vals, are not too much. It is well to drink a glass 
or two before breakfast. If to this morning 
drink there is added, say, a tablespoonf ul of bran, 
it is very effective. Water taken at mealtime 
may increase the tendency to constipation. 

Laxative Foods 

An apple or two, an orange or two, or a few 
dates before breakfast, may be sufficient in many 
cases to establish regularity. Prune sauce is a 
good daily dish for one of constipated habit. A 
tablespoonf ul of olive oil, taken at mealtime, with 
salad or otherwise, will act as a gentle laxative. 



1 Spastic constipation is made worse by a coarse diet, but most per- 
sons suffer from the atonic form, which is benefited by coarse food. 

2 In some cases, green vegetables seem to increase constipation. 



30 Constipation 

Honey and other sweets are laxative. Prob- 
ably the sugar in fruits is the important laxative 
factor, though the acids, as in oranges, have a 
similar effect. 

Whole grains, as whole wheat, brown rice, 
Graham flour, unbolted corn meal, are laxative, 
whether made into bread or into porridge. Boiled 
whole wheat is an excellent but much-neglected 
dish. It is delicious eaten with cream. The 
principal objection to it (which is not a valid 
one) is that it requires too much mastication for 
this fast age. The same may be said of brown, 
or unmilled rice. It requires more mastication 
than the hasty eater is disposed to give it, and 
for this reason it is liable to be neglected in favor 
of the softer white rice. But it is far superior 
to the latter in that it requires more mastication, 
furnishes more residue to stimulate bowel move- 
ment, and in addition contains valuable nutritive 
elements that are removed from the white rice. 
Bran may be spread dry on the breakfast mush 
in such quantity as may be necessary. 

Bread should be made of either whole-wheat 
or Graham flour. If white flour is used, the lax- 
ative effect can be obtained by adding sufficient 
bran to the dough. Bran bread thus made, though 
laxative, does not contain the whole wheat, and 
is therefore inferior in nutritive value to bread 
made from the whole-wheat berry. But it is 
almost impossible to obtain the latter. The bak- 



Cause, Prevention, mid Cure 31 

eries do not make it, and there is very little real 
whole-wheat flour on the market. For this rea- 
son it is an excellent plan to purchase a small 
mill and grind one's own wheat for gems, rolls, 
etc., and for Graham mush. 

Fruits, generally, are laxative. The objection 
to their use is that fruits which ferment, with the 
production of gas, tend to delay bowel action. 
Such should be avoided. Of dried fruits, figs, 
dates, and prunes are particularly valuable, the 
dates and figs being eaten uncooked, or cooked 
with a cereal in the form of porridge. Figs, espe- 
cially the California Mission figs, may be steamed. 
The laxative effect of prunes may be increased by 
placing in the vessel in which the prunes are 
stewing, a bag containing senna leaves and pods. 
Of fresh fruits, oranges and apples, eaten before 
breakfast, are especially valuable, but almost any 
of the fruits increase bowel movement. 

Vegetables, generally, are laxative, except such 
as form gas in the intestine. The production of 
gas is usually accompanied by delayed movement. 
Because of the impression that it is too expen- 
sive, too little vegetable food is eaten. Consid- 
ering the number of calories such food furnishes, 
it is expensive. One may get the same amount 
of protein, fats, and carbohydrates for very much 
less money by using largely of the cereals. But 
when one considers that a diet in which the ce- 
reals is the prominent element is not a balanced 



32 Constipation 

diet, that it lacks just the things that are fur- 
nished by the vegetables, the latter appear in their 
true role, as necessities rather than as luxuries. 
Probably very few who do not have their own 
gardens eat as much green vegetable food as they 
should. Owing to the small calorific value of 
such foods, it is not easy to eat too much of them. 
Those who eat freely of vegetables, as a rule have 
no difficulty in regard to constipation. 

One objection sometimes made to the vegeta- 
rian diet is that it is too bulky — that on such a 
diet one must eat too large a quantity in order 
to obtain sufficient nourishment. This statement 
is not true provided one makes a wise selection 
of foods. But the converse is true. When one 
uses very freely of animal foods, one does not in- 
clude enough bulky food to give adequate stim- 
ulation to the intestinal function. For this reason 
a highly animal diet is liable to be constipating. 

It may be worth while here to give the sub- 
stance of an article by Dr. L. H. Newburgh, which 
appeared in the Boston Medical and Surgical Jour- 
nal of May 22, 1913. Dr. Newburgh says: 

" If we investigate the habits of persons who 
are suffering from habitual constipation, we find 
that the disease has usually followed certain defi- 
nite changes in the diet. If these dietetic changes 
are adopted by a class of people who then become 
constipated as a class, we are more justified in 
believing that this factor is a causal one than if 



Cause, Prevention, and Cure 33 

we can merely discover isolated individuals who 
have become constipated at some period after 
changes in diet have taken place." 

He then relates that Russian Jews who have 
come to the United States, present themselves in 
large numbers at the out-patient department of 
the Massachusetts General Hospital, for the relief 
of constipation. Questioning many of these per- 
sons, he found that in Russia they had access to 
green vegetables, which they ate at one or two 
meals a day. Meat was seldom eaten, and bread 
of the coarsest variety was often the main article 
of diet. Milk, cream, and potatoes were plentiful, 
and cereals were a constant constituent of their 
dietary. Coming to this country, they take very 
kindly to the American beef and to white-flour 
bread, and they very soon tire of cereals, and live 
on a diet lacking in bulk on account of the absence 
of green vegetables and the coarse cellulose cover- 
ing of the whole cereals. 

Questioning isolated foreigners of other races, 
who had constipation, he found that they also had 
adopted the American diet of white bread and 
meat. He found that by adding proper articles 
of food to their diet the constipation ceased. He 
says further: 

" The logical treatment of constipation must, 
then, consist in giving our patient a diet which 
contains sufficient bulk in the form of cellulose to 
make the bowels move normally. The presence 



34 Constipation 

of cellulose in the diet presumably means normal 
defecation, for the following reason : Cellulose has 
the property of holding large quantities of water. 
Bran soaked in hot water for two hours increases 
its volume threefold. Since it is not absorbed by 
the intestinal tract, it must consequently add two 
qualities to the feces, bulkiness and softness." 

Newburgh gives the following as very nearly 
the typical history of this class of patients : Leav- 
ing off native diet, they become progressively more 
constipated; there may be hyperacidity and gas- 
tric distress. The physician probably reduces the 
coarseness and bulk of the diet, thinking the symp- 
toms to be due to these two factors ; and the pa- 
tients, of course, go from bad to worse. 

The most generally useful articles of diet in 
this condition are : Of the cereals, oatmeal, corn- 
meal, and cracked wheat; of the vegetables, let- 
tuce, cauliflower, celery, cabbage, spinach, aspar- 
agus, tomatoes, beans, and peas; of the fruits, 
apples, grapes, prunes with the skins, dates, figs, 
and berries. He advises against the use of lax- 
atives. 

Constipating Foods 

The principal constipating foods are: Dena- 
tured or refined cereals, as white flour, white 
bread, white rice, tapioca, cornmeal, cornstarch, 
and some of the carton breakfast foods ; and also 
concentrated animal foods that furnish a mini- 



Cause, Prevention, and Cure 35 

mum of residue, such as meat, milk, and eggs. 

Milk is constipating only in that it furnishes 
no residue. As an addition to foods furnishing 
an abundant residue, it is not objectionable, 
though boiled milk in some cases seems to have 
a distinctly constipating tendency. As milk comes 
nearer to being an all-round article of diet than 
any other food, supplying the vitamines, mineral 
elements, and certain amino acids lacking in the 
cereals, legumes, etc., it should be used in connec- 
tion with a vegetarian diet, unless there is some 
definite reason why it should not be used. 

According to Gant, " constipation may be sec- 
ondary to dietetic errors where the food consumed 
contains too little water, insufficient fat, or not 
enough cellulose. Persons who partake largely of 
vegetables containing cellulose are prone to have 
more normal evacuations than those living prin- 
cipally upon a meat diet, for the reason that the 
former tends to excite a more healthy peristalsis 
than does the latter; and further, because the 
feces are softer and more easily moved along the 
intestinal tract." 

Tea, because of the contained tannin, is espe- 
cially bad in constipation. Other foods which fail 
to furnish sufficient residue to stimulate the bow- 
els to action, are meat, eggs, milk, white bread, 
and ordinary white rice. Some persons find black- 
berries constipating on account of an astringent 
principle which they contain. 






r^^ 










jF 






s ^^ 




▼^^NsS-^ 



- ALL FOURS ■ 
An Exercise for Strengthen in g the Muscles of the Abdomen 



Cause, Prevention, and Cure 37 

Exercise 

Exercise is an important factor in the correc- 
tion of constipation. But as with any other good 
thing, it is possible to take too much of it. One 
who has not been used to exercise, may, by begin- 
ning suddenly a course of strenuous work, do 
himself more harm than good. 

In taking any of the following exercises, do not 
continue them to the point where they produce an 
unpleasant effect. These directions are merely 
suggestive. It is not necessary to take the exer- 
cises as prescribed; the patient may vary them 
from day to day. 

Any exercise which brings into play the abdom- 
inal muscles, — such as horseback riding, rowing, 
walking, gardening, or outdoor games, like ten- 
nis, — is of value in constipation. Sweeping, 
scrubbing, and other forms of household work are 
good for the abdominal muscles. The disadvan- 
tage is the dust and the monotony. 

For special exercises the following are sug- 
gested, though there are others just as good: 

Fobwabd Bending: 

1. Stand with hands at sides. 

2. On toes rise, hands upward stretch, palms forward. 

Reach as high as possible. 

3. Slowly bend, carrying the arms downward till fingers 

touch floor if possible, bending only at the hips. 
Many persons will find that they cannot touch the 
floor in this way. 



38 Constipation 

4. To position. 
Repeat six to ten times. 
Body Side-bending: 

1. Body erect, heels together, hands at sides. 

2. Hands on hips, fingers forward, thumbs back. 

3. Bend to right and then to left, as far as possible. 
Repeat six to ten times. 

Body Twisting: 

1. Body erect, heels together, hands at sides. 

2. Arms sidewise stretch, level with shoulders, palms 

down. 

3. Twist body to right as far as possible, then to left 
Alternate six to ten times. 

Forward and Backward Bending: 

1. Hands on hips, fingers forward, thumbs back. 

2. Bend slowly forward as far as possible, then backward 

as far as possible. 
Alternate six to ten or more times. 

Thigh Flexion: 

1. Lie on back on the floor or on a couch. 

2. Draw the right thigh toward the body as closely as 

possible, allowing the knee to bend, then lower it to 
position. 

3. The same with left leg. 

Alternate six to ten or more times. Then flex both at the 
same time six to ten times. 

Leg Raising: 

Similar to the above, but do not bend the knees. Lying 
on back, carry the leg as high as possible, first the 
right, then the left, alternate, then together. 

Trunk Raising: 

1. Lie on back, with toes under a sofa or other furniture, 

and hands on hips as in side-bending. 

2. Rise to a sitting position and sink back slowly. 
Alternate six to ten or more times. 



Cause, Prevention, and Cure 39 

This exercise may be varied by clasping the fingers at the 
back of the head for position 1. 

These exercises may be made considerably 
longer if desired, or they may be varied. If they 
become monotonous, a series of imitative exer- 
cises may be devised. Here is one entitled — 

Turning- the Crank 

Imagine a crank with a swing that on the down- 
ward stroke reaches nearly to the floor, and on 
the upward stroke reaches above the level of the 
head. Stand with right foot advanced in a some- 
what rigid attitude, take hold of the imaginary 
crank with both hands, push forward, then down- 
ward, then pull toward you, then upward, de- 
scribing a circle, exerting all your strength. At 
one time your arms will be outstretched; at an- 
other drawn in, or flexed. If your muscles are 
energized during this exercise, you will probably 
be breathing quite rapidly after two or three 
turns, unless you are an athlete, and you will find 
it vigorous work. In fact, by antagonizing one 
set of muscles with another, you can make the 
exercise as vigorous as you like. And you will 
note that the abdominal muscles come in for their 
full share of the exercise. 

You may vary the exercise by putting the left 
foot forward instead of the right, and " unwind- 
ing " the crank. 

Another imitative exercise is — 



40 Constipation 

Pulling: the Rope 

Stand with one foot forward, — the right for a 
while, then the left, — and imagine yourself pull- 
ing in on a heavy rope, say two or three feet at 
a time. Reach far forward, grasp the rope, and 
as you lean back pull hard on the rope ; then reach 
forward and take another pull, and so on until 
you are tired. 

Another resistance exercise, in which arms, 
trunk, and limbs are all exercised, is — 

Piling the Stones 

Imagine yourself about to transfer a pile of 
stones, one at a time, from one pile to another. 
Stand with outstretched legs, lean far out to the 
right, bending the right knee, and grasp a stone 
as far from you as possible. Assume the erect 
position, then bend to the left, flexing the left 
knee, and place the stone as far to the left as 
possible. Place, ten, fifteen, twenty-five, fifty, or 
one hundred stones in this way. 

These exercises are perhaps best taken in con- 
nection with the morning air bath on rising; that 
is, in the nude. 

The value of these exercises is increased if they 
are made " resistive ; " that is, if in performing 
them every movement is resisted by the antago- 
nistic muscles. It is possible to make these re- 
sistive movements as severe and strenuous as 
anv one may desire. 



Cause, Prevention, and Cure 41 

Deep Breathing 

Deep breathing is an excellent exercise for the 
relief of constipation. Not only does the oxygena- 
tion of the blood improve the abdominal functions, 
but the use of the diaphragm and the abdominal 
muscles in deep abdominal breathing gives to the 
abdominal contents the best kind of churning or 
massage. 

Deep breathing is best practised in the open 
air. The clothing should be loose, so as to give 
full play to the lungs. One may begin breathing 
in slowly until the lungs seem to be full, hold the 
breath for a moment, and then take in another 
breath. In exhaling, the breath should pass out 
quietly until the lungs seem to be empty; then 
exhale another breath if possible. One would in 
this way take three or four breaths in a minute. 
This exercise calls into play some of the lung cells 
that are seldom used. 

Another method is to breathe with little inspi- 
rations, say four, then hold the breath a moment ; 
then take four more little inspirations, then hold 
the breath again for a moment. Continue this 
until not another inspiration can be taken; then 
after holding the full inspiration for a few mo- 
ments, breathe out in little puffs, four at a time, 
followed by a pause, until the last possible breath 
is driven from the lungs. A few breaths like this 
will send the blood tingling through the veins, 
and incidentally the abdominal organs will receive 



Iff 




Arms Outstretched Up and Down 




Turning Movement Leaning — Right and Left 

WAND EXERCISES 
42 



Cause, Prevention, and Cure 43 

a very efficient massage, or manipulation. The 
rapid alternate compression of diaphragm and 
abdominal muscles without breathing, so as to 
move the abdominal wall rapidly forward and 
back, is a most effective measure, and can be 
taken almost anywhere several times a day. 

The accompanying illustrations of wand exer- 
cises are self-explanatory. The movements illus- 
trated are all excellent for the development of the 
abdominal muscles, as is also the exercise pic- 
tured on page 36, which consists of alternately 
raising and lowering of the body by means of the 
arm muscles. 

Pantin? 

Another excellent exercise is " panting." With 
mouth open, take short, rapid, forcible breaths, 
say about two hundred a minute. This is a fine 
exercise for the diaphragm, and a good massage 
movement for the abdominal organs, encouraging 
the flow of bile, which is an intestinal lubricant, 
as well as one of the digestive juices. 

It should not be forgotten that walking is one 
of the most healthful exercises one can take. If 
persons of sedentary habits would walk to and 
from their work, would use the street car and 
private motor vehicle less, and would learn to 
enjoy walking just for the sake of walking, thsy 
would have less trouble with intestinal stagna- 
tion. 






1 






Forward Bending Forward and Backward 




Stretching Exercise of Chest and Abdomen 

WAND AND OTHER EXERCISES 

44 



Cause, Prevention, and Cure 45 

Preventive Exercises 

Dr. Mosher, in the New York Medical Journal, 
has suggested the following exercises to aid di- 
gestion, prevent constipation, and strengthen the 
abdominal wall: 

1. Patient lying on back, with bladder empty; knees bent. 

Gently stroke the abdomen down along inside of left 
groin from the ribs to pubis six times. 

2. Stroke three times across the abdomen along the navel 

line, from top of right groin to top of left groin, then 
down, as in exercise 1. 

3. Draw lower abdomen in forcibly by muscular contraction, 

and imitate the movement made when taking a long, 
restful yawn. Breathe in slowly all the air possible, 
stretch trunk and neck upward, and then as slowly 
breathe out all the air taken in. Repeat from six to 
eight times. The exercise can also be taken sitting and 
standing. It should be repeated often when there is sag- 
ging of the abdominal organs. 

4. Forcibly draw in the lower abdominal wall by muscular 

contraction, then raise it and hold long enough to count 
ten. Do this three times. Rest and repeat 

When the abdomen is distended by gas, insert 
small tube (the rectal point of a syringe) in the 
rectum before beginning the exercise. If retained, 
it will let out the gas as fast as it is carried down. 
Never apply pressure below and to the inside of 
the right groin (region of appendix). 

These exercises should be taken by every one 
on retiring, to overcome the sagging of the ab- 
dominal organs due to a standing or sitting pos- 
ture. They may be repeated for one-half hour or 
more if indigestion or gas is present. 



46 Constipation 

Clothing 

Without doubt, clothing that constricts the ab- 
domen, especially clothing that forces the abdom- 
inal organs downward and compresses them, may, 
by forming kinks in the intestine, favor intestinal 
stagnation. For this reason, an important cor- 
rective measure is the substitution of rational 
clothing for that which unnecessarily constricts. 
One form of constriction is in some cases an ad- 
vantage. In cases where, because of the weakness 
of the abdominal wall, the abdominal contents 
sag, it is a great advantage to provide an appro- 
priate abdominal supporter, which will hold the 
organs more nearly in their proper relations. 
This measure alone will remove some of the of- 
fending kinks, and thus afford a freer passage 
for the intestinal contents. 

Posture 

Slouchy, sagging postures, the result of neglect 
to energize the erector muscles of the back, favor 
sagging of the abdominal contents. The habitual 
assumption of an erect posture is therefore a val- 
uable measure for the relief of constipation. One 
should sit and stand with the chest raised and the 
abdomen drawn in. The exercises suggested by 
Dr. Mosher, as previously given, will be found 
an aid in the acquiring of a correct sitting and 
standing posture. 



Cause, Prevention, and Cure 47 

Massage 

Massage is an excellent treatment for consti- 
pation. It is best administered by a trained as- 
sistant, but the patient can give himself efficient 
massage. 

The position to assume for massage is that of 
lying on the back, with the knees partly drawn 
up, in order to relax the abdominal muscles. 
Kneading movements should follow the general 
course of the large bowel. It will be remembered 
that the colon begins at the right groin, goes up- 
ward to near the lower border of the ribs, then 
across to the left, and finally down the left side to 
the left groin. 

As the kneading operation is an attempt to 
force the bowel contents along so as to make way 
for those above, the kneading should begin at the 
left groin, the effort being to strip the bowel of 
the contents, driving them toward the rectum in 
the center. 

Next, the descending colon should receive atten- 
tion, the kneading being so directed as to force 
the fecal matter down to the left grbin. Then 
the transverse colon should be stripped by knead- 
ing movements tending to drive the contents to 
the left. Finally, the ascending colon should re- 
ceive attention, care being taken, however, to 
avoid pressure in the region of the appendix. 

Another form of massage is reflex massage, 
performed either with a feather or the finger tip, 



48 Constipation 

touching the skin very lightly. If a circle is thus 
described around the navel, the tickling sensa- 
tion will be accompanied by movements of the 
underlying muscles, and also by movements of the 
intestinal muscles. 

Owing to the fact that it is difficult for one to 
practise deep kneading on his own abdomen, some 
patients make use of a cannon ball for this pur- 
pose. A six-pound iron ball is about the right 
size. It should preferably be covered with leather. 
To use it, the patient lies on his back and rolls 
the ball in a circle, clockwise, over the abdomen, 
following approximately the course of the colon. 
Deep and effective pressure can thus be made 
without great exertion. 

Vibration 

Vibration over the liver, either by a skilled 
masseur, or by means of a mechanical or electric 
vibrator, is an efficient stimulant to biliary secre- 
tion, and therefore to intestinal activity. 

Electricity 

Doubtless the stimulation of the abdominal 
muscles by electricity tones up the functions and 
helps to relieve constipation. Two sponge elec- 
trodes may be used over the abdomen, kneading 
with one or both. A flat electrode may be placed 
at the back or feet; or a special fusiform elec- 
trode may be inserted in the rectum, and a sponge 



Cause, Prevention, and Cure 49 

electrode may be used to knead the abdomen. 
The faradic current, or better, the sinusoidal cur- 
rent, may be used. On the whole, however, as 
good results may be obtained by other measures 
as by the use of electricity. 

Mind Cure 

And right here will the reader permit a word 
in favor of " mind cure " ? However men may 
scout the idea, the mind has an appreciable effect 
on the bodily functions. It is owing to this fact 
that so many fraudulent remedies — such as a tin 
can tied to the ankle by a string — have per- 
formed undoubted cures. While taking any exer- 
cise or massage, the patient should keep in mind 
the object of the treatment, and try to picture it 
accomplishing the desired end. This visualizing 
the cure is not without its effect. Hopefulness is 
a strong factor in the cure of constipation. As 
has been said previously, depressed mental states 
tend to produce constipation. Gant writes thus 
concerning the effect of the mind upon this 
malady : 

" The mind has a powerful influence for good 
or bad upon the act of defecation. Consequently, 
persons who permit themselves to become greatly 
worried and excited because they do not have an 
action when they think they should, or because 
the amount, consistence, or shape of the stool is 



50 Constipation 

not up to their standard, aggravate their condi- 
tion by working themselves into such a nervous 
state that they are unable to concentrate the 
mind, and in this way assist in the act of defeca- 
tion when the time for the expulsion of the feces 
has arrived. 

Gant also believes that constipation in the leis- 
ure class may be largely mental, from dwelling 
too much on the fact that they do not have their 
regular morning evacuation. Worry over what 
seems to be constipation will in a short time 
make it real. 

Temporary Relief 

Medicinal laxatives are best avoided in con- 
stipation. If a medicinal laxative is used at all, 
it should be only as a temporary expedient. 
Among the mild and comparatively harmless lax- 
atives are salt water (two heaping teaspoonfuls 
salt to a quart of water) and cascara sagrada. 
Cascara does not seem to require an increasing 
dosage. But in time, if it is used continuously in 
large doses, the effect is irritant to the intestine. 
It causes no griping, and is fairly quick in action. 
Aloes, a very commonly used laxative, which also 
causes no griping, is slow in action, and should 
be used in the evening for effect in the morning. 
It is worthless where a quick effect is desired. 
Castor oil acts in four or five hours. It is good 
in acute constipation, or as an emergency meas- 



Cause, Prevention, and Cure 51 

ure in chronic constipation. Its great drawback 
is its unpleasant taste. In nearly all cases, if 
proper hygienic measures are taken, drug reme- 
dies for constipation may after a time be dis- 
pensed with entirely. 

The Enema 

An enema is often an effective measure for 
temporary relief, and is harmless if not too often 
resorted to. It may be taken sitting on the seat 
of the toilet, or lying down. It may be advanta- 
geous to lie, either on the back or the left side 
(some say the right) , with the hips slightly ele- 
vated, though where a comparatively small amount 
of water is used, the position does not matter. 
The custom, one time prevalent, of using large 
quantities of water, not only causes distress, but 
may be harmful through distention of the bowel. 
It is better to use not more than a quart at a 
time, and to repeat after the bowel has been 
partly relieved of its contents. 

It should be remembered that the addition of 
water to the fecal contents, may facilitate the ab- 
sorption of some of the poisons that have been 
forming in the lower bowel, and that the injection 
of large quantities of water may carry some of 
this poisonous matter back to a portion of the 
bowel where absorption is more active than it is 
near the termination. This fact may explain the 



52 Constipation 

headaches that sometimes follow the use of the 
enema. 

The temperature of the water should be nearly 
that of the body. The addition of a teaspoonful 
of salt to a quart of water helps to prevent grip- 
ing. If it is necessary to continue the enema proc- 
ess for a number of days, the quantity and tem- 
perature of the water should be decreased a little 
every day, until finally only a small quantity of 
very cold water is used. It might begin, for in- 
stance, with four pints of water at 95° and dimin- 
ish one-half pint and five degrees a day until in 
nine days the amount is one-half pint, and the 
temperature 60°. If a plain water enema is not 
sufficiently effective, Castile soap may be added, 
just sufficient to color the water. Suds should not 
be used, as that would introduce gas into the 
bowel. 

Mechanical Laxatives 

If a laxative effect more energetic than is ob- 
tained by the foregoing measures is needed, it 
may be secured by the use of a mechanical laxa- 
tive, such as agar-agar. Agar is a vegetable sub- 
stance made from a Japanese seaweed. It has the 
property of absorbing water and of swelling, but 
it is insoluble in the digestive juices, and conse- 
quently passes through the digestive tube un- 
changed, — a jellylike mass, — furnishing bulk and 
stimulation to the intestinal walls, and by its 



Cause, Prevention, and Cure 53 

affinity for water preventing the absorption into 
the blood current of all the water, and the conse- 
quent drying out of the intestinal contents. The 
use of agar results in the formation of larger 
stools, which are neither watery nor hard. 

Agar is perhaps best used, chopped up fine, on 
breakfast food. It should not be cooked in the 
food. The dose is usually two to four teaspoon- 
fuls a day. Each person must determine from 
the effects how much he needs. Those who have 
long been accustomed to a medicinal laxative, 
sometimes add a few drops of cascara or some 
other laxative to the agar, but ordinarily this is 
not necessary. 

As agar is not in general use, it is not kept in 
stock by many of the drug stores, and sometimes 
those who desire to try it have difficulty in obtain- 
ing a supply. But all cities have their bacterio- 
logical laboratories for the study of infectious dis- 
eases, and as these laboratories always use agar, 
perhaps the one in charge can inform the inquirer 
where the laboratory supply is obtained. The agar 
used by laboratories is usually in long strips, and 
should be chopped up fine. Some of the manu- 
facturing drug concerns put up agar in cartons, 
chopped fine and flavored for use as a laxative. 
Any druggist who is assured of a continuous trade 
in agar would carry it in stock. 

Agar is of little value in atonic constipation, 
but is especially valuable in spastic constipation. 



54 Constipation 

It is sometimes used in connection with some mild 
laxative, as cascara sagrada or phenolphthalein. 
The dosage is from one to two heaping table- 
spoonfuls once or twice a day. There may be no 
effect for three or four days. If not by that time, 
increase the amount and frequency till the desired 
effect is obtained, and then gradually decrease. 

Another mechanical laxative is mineral oil, 
sometimes called liquid paraffin. If the oil is too 
light, such an oil as is used in spraying the nose, 
there is liable to be an unpleasant leakage of oil 
from the lower bowel. The heavier oil should be 
used. Usually, however, there will be no leakage 
of oil when the dosage is properly reduced. 

Much has been said about the importance of 
using Russian oil ; but as the oils are now refined, 
the Russian oil has practically no advantage over 
that produced in this country, particularly the 
heavy oil from the California fields. This refined 
mineral oil is harmless. It is not absorbed, but 
traverses the entire length of the bowel, keeping 
the contents in a fluid condition and the tube well 
lubricated. Its action as a laxative is entirely 
mechanical. It acts not only as a laxative, but 
as an antiseptic ; for it retards the action of putre- 
factive germs, and thus lessens the principal fac- 
tor in intestinal auto-intoxication. 

Oil enemas may be used in almost any form of 
constipation, but they are especially valuable in 
spastic constipation, and in cases where there is 



Cause, Prevention, and Cure 55 

a tendency to form hardened masses in the lower 
bowel. If the oil reaches the ascending colon, 
part of it is retained for several days, and gives 
continued benefit. For administration, the pa- 
tient should lie on the left side. The oil should 
be at body temperature, and should be injected 
slowly. A cloth may be pressed around the orifice 
as a protection to the clothing. The dosage varies 
in accordance with what can be retained readily. 
After good results are obtained, the quantity and 
frequency may be gradually decreased. 

Edible oils and fats have the same effect as the 
mineral oils, and in addition they are nourishing. 
For a laxative effect, the quantity taken must be 
more than can be absorbed from the intestinal 
tube. For those who tend to overweight, mineral 
oil is much to be preferred; but for the under- 
weight, edible oil serves a double purpose. An 
infant can be given a quarter of a teaspoonful of 
olive oil once or twice a day after feeding, the 
number of doses being increased until it is given 
at every feeding. Then the dose may be increased 
to a half teaspoonful, limiting the daily dosage to 
half an ounce (four teaspoonfuls) . An adult may 
take from one to two tablespoonfuls three times a 
day, and more, if necessary, unless the increase 
causes digestive disturbance. 

Bran as a laxative may be used in doses of from 
one to two tablespoonfuls several times a day, 
preferably in food, as bran bread, bran gems, 



56 Constipation 

bran biscuit, and in mushes. The bran can be 
incorporated into such foods in sufficient quan- 
tity to produce the desired effect. 

Constipation in Childhood 

Most adults who suffer from obstinate chronic 
constipation can trace the source of their trouble 
to very early childhood. In fact, many cannot 
remember when they were not constipated. Not 
even infants are exempt from this condition. The 
little ones may make no complaint; and if the 
condition is not observed by parents or those in 
charge, it becomes chronic, the children growing 
up victims of a bowel inactivity which is made 
worse by the cathartic or the enema habit. Among 
the causes of constipation in childhood are pain- 
ful evacuation, a diet deficient in coarse material, 
neglect of nature's calls, and insufficient exercise. 

The child may be suffering from anal fissure — 
a painful break or sore in the mucous membrane 
lining the lower end of the digestive tube. It may 
be impossible for mother or nurse to detect any 
sore, but every evacuation causes so much pain 
that the child, in dread, postpones bowel move- 
ment as long as possible. This makes the matter 
worse, for the hardening of the feces makes def- 
ecation more painful, and increases the extent 
of the fissure. Such a condition, if not remedied 
immediately, soon becomes serious. If a child 



Cause, Prevention, and Cure 57 

gives evidence of pain at stool, the doctor should 
be consulted at once. 

Constipation in children is sometimes the direct 
result of an ill-chosen dietary. Babies who after 
weaning are continued on a diet consisting largely 
or wholly of milk, or of foods containing little or 
no " roughage " or residue to stimulate bowel 
action, are liable to be constipated. The remedy 
in this case is obvious. Graham bread, from real 
Graham flour, — not the so-called Graham bread 
so often furnished by bakers, — fruits, vegetables, 
and the whole cereals should be gradually added 
to the diet as baby grows older. 

School children are sometimes unwilling to take 
time from their play for defecation. If parents do 
not guard this point and give proper instruction, 
the children may thus form a habit of neglect that 
tends to grow with age. 

It is wise to help the child to establish early 
a habit of regularity by having it observe a set 
time each day for bowel movement. It should be 
taught to go to the toilet and remain there until 
defecation is completed. The time chosen should 
be one not likely to interfere with the child's reg- 
ular duties or pleasures. If it is after breakfast, 
and the child knows that he must hurry or be late 
to school, or if it is at a time when his fellows 
are likely to want him to join in a game, his 
mind will not be in a condition conducive to good 
bowel action. The time chosen should be prefer- 



58 Constipation 

ably after a meal, for at that time there is a 
natural stimulation of the muscular walls of the 
intestines. Immediately after the evening meal 
may be the best time, if there is not ample time 
after breakfast. 

In some cases, constipation seems to be due to 
a lack of physical exercise. Griffith tells of city 
children, obstinately constipated in winter, who 
had no trouble while living a natural life during 
their summer vacation in the country. Perhaps 
a little more fruit, vegetables, sunlight, and espe- 
cially more exercise, as romping in the woods 
and fields, helped to make the difference. 

Spastic Constipation 

In this form of constipation, the usual remedies 
are worse than useless. Anything that tends to 
stimulate the bowel, such as purgative remedies, 
laxative foods, massage, or electricity, may, by 
stimulating the contraction of the intestinal mus- 
cles, increase the difficulty. In the,se cases the use 
of mineral oil is especially advantageous. So far 
as self-treatment is concerned, the best measures 
are a bland diet, a simple, quiet life, without 
worries, and sedative treatments; but cases of 
spastic constipation require the services of a phy- 
sician, for the condition is constitutional rather 
than local. There is a disarrangement of nervous 
adjustment that requires more than home reme- 
dies for its complete cure. 



Cause, Prevention, and Cure 59 

Constipation in Elderly Men 

Constipation in old men is a very natural result 
of prostatic enlargement. It is stated on good 
authority that at least 30 per cent of men over 
sixty have enlarged prostate. Lying as it does in 
immediate contact with the lower bowel, near its 
outlet, the prostate when enlarged offers a perma- 
nent resistance to the passage of the bowel con- 
tents, which are thus dammed back in the sigmoid 
flexure and the descending colon, in the left groin. 
This condition of mechanical stoppage, or stasis, 
is liable to be followed by two others, bagging of 
the colon by increased pressure, and drying of the 
fecal matter by prolonged absorption of the mois- 
ture. In normal conditions, peristaltic move- 
ments of the bowel wall are favored by the com- 
parative softness and the well-lubricated surface 
of the bowel contents. When fecal masses become 
dry and hard and lose their slippery or glissading 
surface, the muscular wall of the bowel becomes 
helpless, constipation becomes almost hopeless, 
and relief must be had by injection of water or 
oil or other lubricant, unless a brisk cathartic, or 
nature in the form of a diarrhea, causes the bowel 
to exude an emergency supply of lubricating mu- 
cus and to make strenuous muscular contraction. 

As the retention of such masses tends to deaden 
the bowel and render it less responsive to its nor- 
mal stimulus, a temporary mechanical stasis 
caused by pressure of the enlarged prostate may 



60 Constipation 

bring about a condition of chrunic constipation 
involving a change in the bowel itself. For this 
reason an early correction of the obstructing 
cause, before the trouble becomes intractable, is 
important. 

Unfortunately, in this type of constipation, re- 
lief is ordinarily sought by violent straining at 
stool. This practice, by causing a twisting, or 
volvulus, of the sigmoid flexure, adds to the grav- 
ity of the situation. 

Prominent among the personal habits which 
favor the advent of constipation in old men, are 
dietary indiscretions, sexual excitement, and in- 
attention to the regular calls of nature. 

The " increasing girth of the lower torso," as 
Hollis euphemistically terms a pendulous abdo- 
men, even in cases where it is hereditary, may be 
controlled by a " careful dietary, with a goodly 
proportion of fruit and a total abstinence from 
alcohol." Such a regimen " will also assist in 
checking excessive straining at stool, and so pre- 
vent the early onset of irritable heart, in my 
opinion the second most annoying symptom of 
gerontic constipation." 

It goes without saying that the best way to 
treat constipation is to prevent it. In addition to 
the dietetic and other measures suggested in this 
booklet, the elderly man has another preventive 
measure at his disposal. Prostatic pressure may 
be relieved during the act of defecation by making 



Cause, Prevention, and Cure 61 

firm pressure with the index finger on the peri- 
neum " immediately behind the symphysis," or in 
other words, a short distance in front of the anal 
orifice. The finger may be protected by wrapping 
with paper. 

In pathological conditions of the prostate, such 
as cause difficulty of urination, an operation may 
be indicated, though in many cases the enlarge- 
ment is merely a " bogginess " that may be re- 
duced by prostatic massage applied by a compe- 
tent physician. A few massage treatments, if 
properly administered, may relieve bladder dif- 
ficulty, the increasing tendency to constipation, 
and some of the symptoms which the elderly man 
views apprehensively as evidence that his period 
of usefulness is about over. 

Where the condition has so far advanced that 
some drug is necessary to relieve the bowel, the 
aromatic fluid extract of cascara sagrada is prob- 
ably the most suitable for elderly people, as it acts 
preferably on the lower bowel, and does not ordi- 
narily show much tendency to require increasing 
dosage. In some cases where agar does not seem 
to be sufficient to effect a movement, a little cas- 
cara taken with the agar may produce the desired 
effect, the agar serving to keep the stools soft and 
moist, and the cascara acting as a stimulus to the 
lower bowel. But it is better to depend on the 
agar as far as possible, avoiding habitual depend- 
ence upon any drug, however mild. 



62 Constipation 

Summary 

The various methods of relieving constipation 
discussed in this booklet are: 

1. Forming a habit of regularity. 

2. Diet. 

3. Exercise. 

o. Calisthenics. 
J). Imitative. 

4. Deep breathing. 

5. Clothing. 

6. Posture. 

7. Massage 

8. Vibration. 

9. Electricity. 

10. Mental. 

11. Temporary relief: 

a. Drug laxatives. 

&. Enemas. 

c. Mechanical laxatives. 



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